Endometriosis

Chelsea centre for minimally invasive gynaecological surgery and endometriosis

Chelsea and Westminster Hospital is a BSGE accredited endometriosis centre. We see patients from all over the country who have been referred from their GP or hospital consultant because they require a specialist opinion.

We see new patients at any point in their diagnosis and treatment journey. We pride ourselves for providing holistic and patient centred care.

We offer all treatment modalities for endometriosis taking the patient’s circumstances and desires into consideration. Options include medical (hormonal and non-hormonal) and surgical (mostly minimal access, including robotic surgery and, when needed, open surgery).

We work closely with other specialists and allied health professionals and can offer our patients a concurrent review by other specialist if this is suitable for you to help shorten your patient journey and help improve your symptoms as quickly as possible.

We are the only centre in Northwest London to offer robotic surgery for endometriosis patients in the NHS. This technology allows us to perform complex operations with greater precision and collaborate with our colorectal surgical colleagues with ease. As more and more patients are looking to have robot-assisted surgery, we have recently expanded our department with a second robot to help reduce the waiting times for our patients.

Our team

Endometriosis consultants and robotic surgeons:

  • Mr Amer Raza (Service Lead) 
  • Ms Manou Manpreet Kaur
  • Mr Jeffrey Ahmed

Senior specialist registrars with an interest in endometriosis:

  • Mr Thomas Bainton, Research Fellow
  • Ms Sarah Wali, Minimal Access Surgery Fellow 
  • Mr Nicholas Dixon, Advanced laparoscopy ATSM Trainee

Specialist clinical nurses in endometriosis and point of patient contact:

  • Alessandra Musa 
  • Kathryn Main

Multidisciplinary team colleagues:

  • Colorectal Surgeons: Mr Valerio Celentano, Mr Oliver Warren
  • Fertility specialist: Ms Kate Maclaren 
  • Urology specialist: Mr Hama Attar
  • Thoracic surgeon : Mr Simon Jordan 
  • Radiologist: Dr Davies, Dr Hillier, Dr Ioana Papadopoulou
  • Pelvic pain specialist: Bianca Kuehler 
  • Pelvic floor physiotherapist: Miti Rach

What to expect

First appointment

This can be either in person or via telephone consultation. If your appointment is a telephone consultation and you need an examination, then you will be invited to come in for an examination later. You can change your appointment from telephone to in person and vice versa if this is more convenient for you, please email the administrators to do this in advance of your appointment on .

You will be reviewed by a member of the team, either the specialist nurse, senior registrar or consultant who will take a detailed history from you, perform a gynaecological examination if appropriate and make recommendation about further investigations or management in a collaborative approach with you.

It would be helpful if you can bring information about your previous endometriosis management if it is not included in your GP’s referral (eg, private scans and operations).

What happens next?

If your case is complex, we will discuss you at our monthly multidisciplinary team (MDT) meeting to ensure you receive the safest and most appropriate care.

The MDT consists of gynaecologists, colorectal surgeons, urologists, pain management specialists, fertility specialists and radiologists, all with an interest in endometriosis.

It is important that you tell us what your treatment goals are during the clinic so that we can tailor the MDT discussion to you as an individual.

Subsequent appointments

You will follow-up either in person or by telephone to discuss your response to treatment, any new concerns, and outcome of the MDT discussion if your case is complex. In between appointments you can contact us via email and our specialist nurse will get back to you at the earliest opportunity.

Once you are stable on treatment (medical or surgery) we will offer to discharge you so that you can focus your time on things you enjoy. However, for some complex patients being discharged may not be the option that suits them best so we have an option to offer patient initiated follow up for up to two years to give you control over when you would like to be seen by us. If this is an option that you are interested in please ask us in clinic, or we will offer to you if you are suitable.

Estimated waiting times

  • New appointments: 3 months from referral to clinic appointment
  • MDT discussion: 3 months from clinic to being discussed at the MDT.
  • Surgery waiting list: This is variable and depends on the clinical priority:
    • If your condition is concerning for underlying cancer (i.e., there are concerns on your imaging) then your case will be fast tracked as a priority 2 (surgery within 4 weeks)
    • If there are no concerns regarding cancer on your imaging your case is a priority 4 which can take more than 3 months. Our longest waiting time is 12 months.
    • If there are concerns regarding obstruction of your bowel or kidney tube (ureter) your case will be a priority 3 - within 3 months. In an emergency your case will be a priority 1 (within 72 hours)
    • We also organise regular extra operating lists on the weekend to help reduce the waiting times for our patients. If you are available at short notice for an operation, please let us know in clinic / via email so that we can contact you when an extra list is happening.
  • Getting scan results/blood test results: These will be relayed to you at your next clinic appointment. If there is a serious abnormality with your result we will get in touch with you sooner, otherwise it is difficult to communicate results to you outside of scheduled clinic appointments. You can also access the results via your Patients Know Best account or through your GP.
  • Follow up appointments: Variable depending on your management plan and symptoms. Appointments are usually available within 3 months. You can also access us through the endometriosis nurse email .

Contact information

Endometriosis service
Gynaecology Outpatients
Chelsea and Westminster Hospital
1st Floor, Lift Bank B

E: or 

Helpful resources

This section includes self-management strategies to consider combatting endometriosis symptoms.

Education about endometriosis

Social support

Consider joining online or in person endometriosis support groups:

Importance of sleep

Sleep plays an important role in regulating an individual’s quality of life and social, emotional and physical wellbeing. Individuals with endometriosis are prone to issues with sleep. Adult should attempt to obtain 6–9 hours of sleep each night. If you are suffering with your sleeping talk to your GP and read this helpful leaflet.

Physical exercise/yoga/pilates

There is limited research on endometriosis and general physical activity. Self-care and maintaining good physical and psychological health have a positive impact on overall well-being for everyone.

  • Initiate or maintain exercise based on your personal experiences and take a graduated approach to increase physical activity.
  • A simple search of YouTube for yoga for endometriosis
  • Our pain clinic has a plethora of resources on its YouTube channel

Diet

It is too early to make formal recommendations on dietary changes that will improve the lives of those living with endometriosis. Nevertheless, avoiding constipation and known individual triggers of bladder symptoms may be useful. The following dietary modifications may improve symptoms:

  • Green tea, resveratrol (found in grapes), fish oil and soy isoflavones have anti-inflammatory effects (animal studies)
  • Gluten-free diet (especially if coexisting celiac disease)
  • FODMAP diet (low fermentable oligosaccharides, disaccharides, monosaccharides and polyols: may reduce the gastrointestinal symptoms, such as bloating.
  • Endometriosis.net

Emotion-focused strategies

Although more endometriosis specific evidence is needed to support the below strategies, they are known effective interventions in chronic pain more generally. In the absence of harmful side effects, these strategies could be safely trailed by patients.

  • Relaxation, breathing exercises and mindfulness—exercises can be undertaken at home using a variety of websites and/or audio downloads
  • If health-related anxiety and worries are interfering with your activities of daily living or quality of life, then it is important that you are referred for professional psychological support eg CBT, ACT, counselling
  • Free self-referral to Talking Therapies—if you live in another borough find your local service by searching on Google IAPT + name of your borough
  • Freely available basic information on ACT can be found in the first two chapters of ‘ACT made simple’ by Dr Harris (2009)—search ACT made simple in Google Books
  • More information in this patient leaflet

Patient groups and information

Research

We have an active and developing endometriosis research programme at Chelsea and Westminster Hospital and through Imperial College London. Our main research activities are: 

  • ESPRIT Study (Exploring pre-operative prediction of pelvic endometriosis, the inflammatory environment and its response to surgery)
    • Improving the non-invasive prediction of endometriosis to reduce the current extraordinary diagnostic delay
    • Furthering our understanding of the links between endometriosis and inflammation in the womb and the role of surgery in improving this
    • Identification of an accurate biomarker for disease
  • The REGAL trial (Recurrence of Endometriosis: A randomised controlled trial of clinical and cost-effectiveness of Gonadotrophin Releasing Hormone Analogues with add-back hormone replacement therapy versus repeat Laparoscopic surgery) 
    • Identifying the best treatment for recurrence of invasive endometriosis by randomising participants to have either long term medical or surgical treatment.
  • The DIAMOND study (Deep infiltrating endometriosis: management by medical treatment versus early surgery) 
    • Comparing surgery with medical treatment for those with deep endometriosis (confirmed on MRI or previous laparoscopy)
    • Furthering our understanding of the deep physical and mental health burden of endometriosis and the role of different treatment in improving things
    • Trialling less invasive treatments in order to avoid multiple or repeat surgical procedures and limit the collateral damage to healthy ovarian tissue and future fertility, for example alcohol sclerotherapy for treatment of endometriomas.

Who is leading on the research work?

  • Mr Amer Raza –Gynaecologist and Robotic Surgeon, Endometriosis Lead, Chelsea and Westminster Hospital, Honorary Senior Lecturer, Imperial College London 
  • Mr Thomas Bainton – Clinical Research Fellow and Senior Registrar Chelsea and Westminster Hospital, Imperial College London 
  • Prof Mark Johnson – Professor of Obstetrics and Gynaecology Chelsea and Westminster Hospital and Imperial College London 
  • Dr Viki Male – Senior Lecturer Reproductive Immunology, Department of Metabolism, Digestion and Reproduction, Imperial College London

National and international professional events

In our strive to improve the care we offer our patients we routinely engage in quality improvement, service evaluation projects and audits and present our work to peers in the field of endometriosis and minimally invasive surgery.

Surgical video presentations

  • WCE 2023 - Excision of anterior abdominal wall endometriotic nodule and reconstruction: A video vignette
  • AAGL 2022 - Complex endometriosis with disc excision: An educational video (finalist video)
  • BSGE 2022 - Incidental finding of deep infiltrating endometriosis (DIE) causing bilateral hydroureter in a patient with total colectomy and ileoanal pouch and defunctioning ileostomy for inflammatory bowel disease (IBD)
  • BSGE 2022 - Laparoscopic excision of rectovaginal endometriosis: Video laparoscopy demonstrating three methods: Rectal shave, discoid rectal resection with rectal stapler, and segmental anterior resection. Preoperative planning and intraoperative decision making leading to each management option and description of techniques.
  • BSGE 2022 - Identification and protection of the pelvic ureter in cases of invasive endometriosis: A description of a technique for pre-operative ureteric catheterisation without the need for specialist urological input or on table radiography
  • BSGE 2021 - Laparoscopic anterior resection for DIE

Oral presentations

  • WCE 2023 - Surgical training presents a global challenge for treatment of endometriosis: A model for delivery and maintenance in a low-resource setting
  • ESGE 2022 - The unmet need for psychological support for endometriosis related chronic pelvic pain: A review of current clinical practice
  • BSGE 2022 - Anti-Mullerian Hormone (AMH) testing prior to endometrioma surgery in reproductive age women not seeking assisted fertility care: A survey of current UK clinical practice
  • BSGE 2022 - Endometriosis diagnostic index
  • BSGE 2022 - Rectal injury and repair

Poster presentations

  • WEC 2023 - Patient engagement in upcoming PIFU rollout at a BSGE endometriosis centre
  • WEC 2023 - Experience of patients referred to the pain management service for endometriosis chronic pelvic pain at a BSGE endometriosis centre
  • BSGE 2022 - The experience of a BSGE endometriosis centre: A summary of 14 years and 598 cases.
  • BSGE 2021 - Virtual clinic appointments preferences and acceptability 
  • BSGE 2021 - Endometriosis and COVID-19 webinar 

Patient and public involvement

We believe the involvement of patients and their friends and family is key to us providing the best care. We hold regular and free of charge engagement and awareness events.

Below the Belt, the vicious cycle of endometriosis film screening, Oct 2022

We were delighted to host the first ever screening of this impactful film documentary in a healthcare setting. The screening was held in our hospital CW+ MediCinema and attended by Director Shannon Cohn and Women’s Health Ambassador Dame Lesley Regal. We hosted many of our amazing patients in addition to policy makers and other stakeholders.

Endometriosis awareness evening, Apr 2023

An evening of talks and discussion to demystify endometriosis and the patient journey. Multidisciplinary talks and breakout sessions with colorectal surgery, fertility, physiotherapy, psychological support and more.

More information

Collaborations 

  • Endometriosis UK—bowel endometriosis Talk with Mr Raza and Our colorectal surgeon Mr Warren
  • Not defined by endo—Mr Thomas Bainton, our research fellow, in collaboration with not defined by endo, has produced high quality, evidenced based podcasts covering a wide range of endometriosis specific topics (season 3)

Teaching and education

The Chelsea Centre for Minimal Invasive Gynaecology (CCMIG) offers surgical training courses in London, Online & Internationally. We run regular educational courses aimed at gynaecologists at all levels of their careers to give them the knowledge and skill set needed to treat women with a range of gynaecological conditions including endometriosis. Our mission is to train surgeons to the highest standards so that women all over can be offered great care and a minimal access approach to their surgery.

Social media

  • Channel 4 report on endometriosis and the service we provide at Chelsea and Westminster Hospital
  • We have a YouTube channel with a collection of videos and webinars aimed at both patients and gynaecologists
  • We are active on Instagram, showcasing our team, work, and courses (we do not monitor messages on Instagram so please contact us via our email address)
Contributors
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